Provider Demographics
NPI:1346863362
Name:FRONT RANGE UPPER EXTREMITY REHAB, LLC
Entity Type:Organization
Organization Name:FRONT RANGE UPPER EXTREMITY REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:HOERSKE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:720-760-3222
Mailing Address - Street 1:555 MANHATTAN DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4079
Mailing Address - Country:US
Mailing Address - Phone:720-760-3222
Mailing Address - Fax:720-664-6504
Practice Address - Street 1:3775 IRIS AVE STE 2A&B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2043
Practice Address - Country:US
Practice Address - Phone:720-760-3222
Practice Address - Fax:720-664-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty